Blalock Dialysis Center, Inc.

“COMPLIANCE WITH FED/STATE/LOCAL LAWS CFR(s): 494.20 The facility and its staff must operate and furnish services in compliance with applicable Federal, State, and local laws and regulations pertaining to licensure and any other relevant health and safety requirements. This Standard is not met as evidenced by: 48020 Based on observation, interview and record review, the facility’s governing body failed to ensure that no portable fans were in use in the hemodialysis treatment area. Findings: CDC Guidelines for Environmental Infection Control in Health-Care Facilities (2003) revealed the following: “1. Modes of Transmission of Airborne Diseases A variety of airborne infections in susceptible hosts can result from exposures to clinically significant microorganisms released into the air when environmental reservoirs (i.e., soil, water, dust, and decaying organic matter) are disturbed. Once these materials are brought indoors into a health-care facility by any of a number of vehicles (e.g., people, air currents, water, construction materials, and equipment), the attendant microorganisms can proliferate in various indoor ecological niches and, if subsequently disbursed into the air, serve as a source for airborne health-care associated infections.” Vornado User Guide found on vornado.com revealed the following: “Intended Use: This product is intended to circulate the air in indoor living spaces only in the United States. This product is not intended for commercial or industrial use.” Observation of the hemodialysis treatment floor on 11/20/2024 at 10:04 a.m. revealed a Vornado portable fan in use at the nurse’s station. The Vornado fan was blowing in the direction of Patient Care Technician (C) who was providing care to patients at station #s 17, 18 and 19. The Surveyor notified the Facility Administrator on 11/20/2024 that portable fans should not be in use in the hemodialysis treatment area, and she said, “Okay.””

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 48020 Based on observation, interview and record review, the facility’s direct care staff failed to wash/sanitize hands after removal of contaminated gloves: 2 of 5 staff observed: Patient Care Technician (C) and Registered Nurse (A) Findings: Review of the facility’s current policy and procedure: Infection Control: Policy # 05-10 Date Revised 02/01/14, directs the staff as follows: “Directions: 6. “Hand hygiene” includes either washing hands with soap or water, or using a waterless alcohol-based antiseptic had rub with 60-90% alcohol content. Hands should be washed with soap and water if visibly soiled. If not visibly soiled, hand hygiene with alcohol-based hand rub may be used. The CDC recommends that hand washing incorporate rubbing hands together “vigorously” for 15 seconds, that the use of alcohol-based rubs incorporate covering all surfaces of hands and fingers, until hands are dry. Hand hygiene will be followed after glove removal because hands can become contaminated through small defects in gloves and from the outer surface of gloves during glove removal.” Patient Care Technician (C) Observation on 11/202024 at 7:52 a.m., revealed Patient Care Technician (C) touch the hemodialysis screen to show the Surveyor the machine settings. Patient Care Technician (C) then removed her gloves, walked over to the nurse’s station with the Surveyor and touched the keyboard with her contaminated hands. Patient Care Technician (C) failed to perform “hand hygiene” after glove removal per the facility’s policy. The Surveyor immediately notified Patient Care Technician (C) that she failed to wash/sanitize her hands after removing her gloves. Patient Care Technician (C) said, “Okay.” Subsequent observation at 9:39 a.m. revealed Patient Care Technician (C) picking up the patient’s belongings at station #18 with gloved hands. She then walked to the waste receptacle on the way to the weigh scale, discarded her gloves into the waste receptacle, proceeded to weigh scale and touched the button to weigh the patient with her contaminated hands. Patient Care Technician (C) failed to perform “hand hygiene” after glove removal per the facility’s policy. The Surveyor notified Patient Care Technician (C) at 9:41 a.m. that she failed to wash/sanitize her hands after removing her gloves. Patient Care Technician (C) said, “Okay.” Registered Nurse (A) Observation on 11/202024 at 9:36 a.m., revealed Registered Nurse (A) preparing a clean field of supplies for a central venous catheter (CVC) dressing change and hemodialysis treatment initiation for the patient at station #6. During the preparation, Registered Nurse (A) opened the Sharps container lid that was sitting on the floor with his gloved hands. He then removed and discarded the contaminated gloves, picked up new gloves from the clean field with his contaminated hands and dropped them back onto the clean field. Next, he sanitized his hands, picked up the contaminated gloves that he left on the clean field, moved them to other side of the clean field, donned new gloves and proceeded to with the CVC dressing change and hemodialysis treatment initiation. Registered Nurse (A) failed to perform “hand hygiene” after glove removal per the facility’s policy. The Surveyor notified Registered Nurse (A) at 9:58 a.m. that he failed to wash/sanitize his hands after removing his gloves and touching contaminated objects. Registered Nurse (A) said, “Okay.””

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 48020 Based on observation, interview and review the facility’s direct care staff failed to prevent cross contamination by: storing a trash receptacle in a common area near a hemodialysis machine B) storing a biohazard receptacle near the emergency cart. C) storing clean ancillary equipment in the lab area. Findings: Review of the facility’s current policy and procedure: Infection Control: Policy # 05-10 Date Revised 02/01/14, directs the staff as follows: “Directions: 1. Dialysis treatment areas are considered restricted areas. All patients are considered potentially infectious. Standard Precautions are practiced at all times and in all patient areas of the facility. The facility follows CDC and OSHA recommendations.” Observation of the hemodialysis treatment floor: Observation of the hemodialysis treatment floor on 11/20/2024 at 8:13 a.m. revealed a large trash receptacle in the common area leading to the treatment floor. The large trash receptacle was stored inches from the back of hemodialysis machine #2 at station #2 while Patient #5 was receiving hemodialysis. There was not a clear separation of clean vs. dirty when storing a trash waste receptacle near a hemodialysis machine. Observation of the Emergency Cart: Observation of the Emergency Cart on 11/20/2024 at 8:31 a.m. revealed a biohazard receptacle stored near the emergency cart. The Surveyor could not fully open the second drawer of the Emergency Cart because the biohazard receptacle was stored too close to it. There was not a clear separation of clean vs. dirty when storing a biohazard waste receptacle near the emergency cart near. Observation of the Lab Area: Observation of the Lab Area (across from the Emergency Cart storage area) on 11/20/2024 at 8:33 a.m. revealed an oxygen cylinder stored near the countertop with a centrifuge on it and a biohazard receptacle and lab refrigerator stored beneath it. Observation also revealed a manual blood pressure cart stored near a biohazard waste receptacle. There was not a clear separation of clean vs. dirty when storing the ancillary equipment in the lab area. Interview with Clinical Nurse Manager (B) during a walk-through of the treatment floor, Emergency Cart and Lab Area on 11/20/2024 the confirmed the above findings.”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 48020 Based on observation, interview and record review, the facility’s direct care staff failed to clean and disinfect the citric acid jug wand caps behind 8 of 20 hemodialysis machines: #s 18, 19, 11, 4, 5, 3, 2 and 1 Findings: Review of the facility’s current policy and procedure: Machine Cleaning Between Patients: Policy # 05-80 Date Revised 02/01/14, directs the staff as follows: “Procedure 2. Correct cleaning and disinfection with cloth soaked with bleach 1:100 or other “intermediate level disinfectant” (a disinfectant that kills bacteria and most viruses and is accomplished by using a tuberculocidal ‘hospital disinfectant’) of environmental surfaces including patient chair surfaces in Trendelenburg position, dialysis equipment surfaces, blood pressure cuff, call bells / remote control, adjacent tables, dialysate lines, IV poles and outside of the dialysate jugs must be performed between patient uses to prevent transmission of dangerous pathogens. Thoroughly wipe down all exterior surfaces on the machine. Discard any contaminated supplies, barrier etc. into the biohazard waste and clean up the area.” Observation on 11/20/2024 at 8:03 a.m. of the following B Braun Dialog+ Adimea hemodialysis machines accompanied by the facility’s Clinical Nurse Manager revealed 10L Citric Acid 50% jugs attached to the back of hemodialysis machine with dirty yellow wand caps that had not been cleaned and disinfected: B Braun Dialog+ Adimea hemodialysis machine # 18 located at station # 18 B Braun Dialog+ Adimea hemodialysis machine # 19 located at station # 19 B Braun Dialog+ Adimea hemodialysis machine # 11 located at station # 11 B Braun Dialog+ Adimea hemodialysis machine # 4 located at station # 4 B Braun Dialog+ Adimea hemodialysis machine # 5 located at station # 5 B Braun Dialog+ Adimea hemodialysis machine # 3 located at station # 3 B Braun Dialog+ Adimea hemodialysis machine # 2 located at station # 2 B Braun Dialog+ Adimea hemodialysis machine # 1 located at station # 1 Interview with the Clinical Nurse Manager during the observation confirmed the citric acid wand caps were dirty and had not been cleaned and disinfected.”

“POC-OUTCOME NOT ACHIEVED-ADJUST POC CFR(s): 494.90(b)(3) If the expected outcome is not achieved, the interdisciplinary team must adjust the patient’s plan of care to achieve the specified goals. When a patient is unable to achieve the desired outcomes, the team must- (i) Adjust the plan of care to reflect the patient’s current condition; (ii) Document in the record the reasons why the patient was unable to achieve the goals; and (iii) Implement plan of care changes to address the issues identified in paragraph (b)(3)(ii) of this section. This Standard is not met as evidenced by: 48020 Based on observation and interview, the facility’s interdisciplinary team failed to complete interdisciplinary care plan on patients in 5 of 7 sampled patients: Patient #s 1, 2, 3, 4 and 6 Findings: Patient #1 On 11/20/2024 at 7:34 a.m. Patient #1 was observed on the treatment floor of the facility at station #19. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 343 mL/hr via a left lower arm vascular access. Review of the patient’s clinical record (demographic data) revealed the patient was admitted to the facility on 02/21/2022. Review of the patient’s annual comprehensive interdisciplinary plan of care (POC) revealed the POC was signed and dated by the registered nurse, social worker and physician on 02/28/2024 and the registered dietitian on 03/06/2024. The patient did not sign or date the POC. There was no documentation of the patient’s participation in the plan of care. Review of the patient’s annual comprehensive interdisciplinary plan of care (POC) revealed the POC was signed by Clinical Nurse Manager (B). Review of the Personnel File Worksheet revealed Clinical Nurse Manager (B’s) date of hire as 08/01/2024. There was no documentation of the registered nurse’s participation in the plan of care from 02/28/2024 - 08/01/2024. Patient #2 On 11/20/2024 at 8:02 a.m. Patient #2 was observed on the treatment floor of the facility at station #4. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 1000 mL/hr via a left upper arm vascular access. Review of the patient’s clinical record (demographic data) revealed the patient was admitted to the facility on 09/20/2023. Review of the patient’s 90-day comprehensive interdisciplinary plan of care (POC) revealed the POC was signed and dated by the registered nurse, registered dietitian, social worker and physician on 12/29/2023. The patient did not sign or date the POC. There was no documentation of the patient’s participation in the plan of care. Review of the patient’s annual comprehensive interdisciplinary plan of care (POC) revealed the POC was signed by Clinical Nurse Manager (B). Review of the Personnel File Worksheet revealed Clinical Nurse Manager (B’s) date of hire as 08/01/2024. There was no documentation of the registered nurse’s participation in the plan of care from 12/29/2023 - 08/01/2024. Interview with Clinical Nurse Manager (B) on 11/20/2024 at 3:30 p.m. confirmed he said, “I’ve been here a couple of months.” When the Surveyor questioned Clinical Nurse Manager (B) about signing and dating the POCs for Patient #s 1 and 2 he said, “I thought I was signing them for today.” Patient #3 On 11/20/2024 at 8:03 a.m. Patient #3 was observed on the treatment floor of the facility at station #5. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 600 mL/hr via a right central venous catheter. Review of the patient’s clinical record (demographic data) revealed the patient was admitted to the facility on 10/04/2015. Review of the patient’s annual comprehensive interdisciplinary plan of care (POC) revealed the POC was signed and dated by the registered nurse and physician on 10/07/2024, registered dietitian on 10/18/2024 and social worker on 10/25/2024. The patient did not sign or date the POC. There was no documentation of the patient’s participation in the plan of care. Patient #4 On 11/20/2024 at 8:08 a.m. Patient #4 was observed on the treatment floor of the facility at station #3. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 720 mL/hr. via a right central venous catheter. Review of the patient’s clinical record (demographic data) revealed the patient was admitted to the facility on 04/01/2022. Review of the patient’s annual comprehensive interdisciplinary plan of care (POC) revealed the POC was signed and dated by the registered nurse and physician on 04/08/20224 and registered dietitian on 04/24/2024. The social worker did not sign the POC until 11/08/2024. The patient was not presented the POC to sign or date since it was missing the social worker’s assessment from 04/08/2024 - 11/08/2024. Patient #6 On 11/20/2024 at 8:16 a.m. Patient #6 was observed on the treatment floor of the facility at station #1. The patient was receiving hemodialysis treatment at a blood flow rate of 350 mL/min and ultrafiltration rate of 1000 mL/hr via a left lower arm vascular access. Review of the patient’s clinical record (demographic data) revealed the patient was admitted to the facility on 05/20/2019. Review of the patient’s annual comprehensive interdisciplinary plan of care (POC) revealed the POC was signed and dated by the registered nurse on 04/08/20224 and registered dietitian on 04/18/2024. The social worker did not sign the POC until 11/08/2024. The physician signed but did not date the POC. The patient was not presented the POC to sign or date since it was missing the social worker’s assessment from 04/08/2024 - 11/08/2024. Interview with the Facility Administrator on 11/20/2024 at 4:30 p.m. confirmed the facility had an interim Clinical Nurse Manager (CNM) for the dates in question and they failed to get him to complete the POCs. The facility was also without a social worker for dates in question.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 48020 Based on observation, interview, and record review the facility’s registered nurses: failed to ensure medication prepared for patients are not left unsecured at patients’ chairside and are administered per policy in 6 of 11 patients observed: Patient #s 1, 2, 3, 4, 5 and 6 B) failed to conduct assessments when patients experienced a change in condition during hemodialysis treatment in 2 of 7 sampled patients: Patient #s 4 and 6 Findings Review of the facility’s current policy and procedure: Oral Medication Administration Policy # 14-00 Date revised: 01/01/14, directs the staff as follows: “12. Remain with the patient until each medication is swallowed. Never leave medication at the patient’s bedside.” Review of the facility’s current Policy and Procedure on Pre Dialysis Assessment Patient and Post Dialysis Assessment Patient directs staff as follows: “CN Must be notified of decrease in UF” Medication Storage: Patient #1 On 11/20/2024 at 7:34 a.m. Patient #1 was observed on the treatment floor of the facility at station #19. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 343 mL/hr. Observation of the patient’s chairside table revealed a cup with one white tablet and one orange capsule left unsecured at the chairside. The medication was not in view of the registered nurse. One registered nurse was providing care to other patients and the other registered nurse was on the computer at the nurses station. Review of the patient’s clinical record revealed a physician’s order dated 11/14/2024 for ferrous sulfate 65 mg Oral 1st, 2nd & 3rd tx of week and Vitamin D (calcitriol) Oral 0.25 mcg Oral 1st, 2nd & 3rd tx of week. Review of the patient’s treatment sheet revealed documentation by the registered nurse that the patient was administered ferrous sulfate 65 mg and calcitriol 0.25 mcg at 9:05 a.m. Patient #2 On 11/20/2024 at 8:02 a.m. Patient #2 was observed on the treatment floor of the facility at station #4. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 1000 mL/hr. Observation of the patient’s chairside table revealed a cup with two white tablets, one light green tablet and three orange capsules left unsecured at the chairside. The medication was not in view of the registered nurse. One registered nurse was providing care to other patients and the other registered nurse was on the computer at the nurses station. Review of the patient’s clinical record revealed a physician’s order dated 11/04/2024 for ferrous sulfate 130 mg Oral 1st, 2nd & 3rd tx of week, Sensipar 30 mg Oral 1st, 2nd & 3rd tx of week and Vitamin D (calcitriol) Oral 1.50 mcg Oral 1st, 2nd & 3rd tx of week. Review of the patient’s treatment sheet revealed documentation by the registered nurse that the patient was administered ferrous sulfate 130 mg, Sensipar 30 mg and calcitriol 1.50 mcg at 9:56 a.m. Patient #3 On 11/20/2024 at 8:03 a.m. Patient #3 was observed on the treatment floor of the facility at station #5. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and dialysate flow rate of 600 mL/hr. Observation of the patient’s chairside table revealed a cup with two white tablets, one large pink tablet and one orange capsule left unsecured at the chairside. The medication was not in view of the registered nurse. One registered nurse was providing care to other patients and the other registered nurse was on the computer at the nurses station. Review of the patient’s clinical record revealed a physician’s order dated 11/01/2024 for ferrous sulfate 130 mg Oral 1st, 2nd & 3rd tx of week, Tums 1000 mg Oral 1st, 2nd & 3rd tx of week and Vitamin D (calcitriol) Oral 0.25 mcg Oral 1st, 2nd & 3rd tx of week. Review of the patient’s treatment sheet revealed documentation by the registered nurse that the patient was administered ferrous sulfate 130 mg, Tums 1000 mg and Vitamin D (calcitriol) 0.25 mcg at 10:00 a.m. Patient #4 On 11/20/2024 at 8:08 a.m. Patient #4 was observed on the treatment floor of the facility at station #3. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 720 mL/hr. Observation of the patient’s chairside table revealed a cup with three large pink tablets left unsecured at the chairside. The medication was not in view of the registered nurse. One registered nurse was providing care to other patients and the other registered nurse was on the computer at the nurses station. Review of the patient’s clinical record revealed a physician’s order dated 11/04/2024 for Tums 3000 mg Oral 1st, 2nd & 3rd tx of week. Review of the patient’s treatment sheet revealed documentation by the registered nurse that the patient was administered Tums 3000 mg at 10:10 a.m. Patient #5 On 11/20/2024 at 8:13 a.m. Patient #5 was observed on the treatment floor of the facility at station #2. The patient was asleep and receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 743 mL/hr. Observation of the patient’s chairside table revealed a cup with two white tablets and one orange capsule left unsecured at the chairside. The medication was not in view of the registered nurse. One registered nurse was providing care to other patients and the other registered nurse was on the computer at the nurses station. Review of the patient’s clinical record revealed a physician’s order dated 11/4/2024 for ferrous sulfate 130 mg Oral 1st, 2nd & 3rd tx of week and Vitamin D (calcitriol) Oral 0.50 mcg Oral 1st, 2nd & 3rd tx of week. Review of the patient’s treatment sheet revealed documentation by the registered nurse that the patient was administered ferrous sulfate 130 mg and Vitamin D (calcitriol) Oral 0.50 mcg at 10:15 a.m. Patient #6 On 11/20/2024 at 8:16 a.m. Patient #6 was observed on the treatment floor of the facility at station #1. The patient was receiving hemodialysis treatment at a blood flow rate of 350 mL/min and ultrafiltration rate of 1000 mL/hr. Observation of the patient’s chairside table revealed a cup with two large pink tablets, one light green tablet and 1 white tablet left unsecured at the chairside. The medication was not in view of the registered nurse. One registered nurse was providing care to other patients and the other registered nurse was on the computer at the nurses station. Review of the patient’s clinical record revealed a physician’s order dated 11/14/2024 for Tums 2000 mg Oral 1st, 2nd & 3rd tx of week, Cinacalcet 60 mg Oral 1st, 2nd & 3rd tx of week and ferrous sulfate 130 mg Oral 1st, 2nd & 3rd tx of week. Review of the patient’s treatment sheet revealed documentation by the registered nurse that the patient was administered Tums 2000 mg, Cinacalcet 60 mg and ferrous sulfate 130 mg at 8:45 a.m. Interview with Clinical Nurse Manager (B) on 11/20/2024 at 8:22 a.m. confirmed the oral medications were left unattended at chairside and not administered per policy for Patient #s 1, 2, 3, 4, 5 and 6. Charge Nurse Notification and Assessment: Patient #4 On 11/20/2024 at 8:08 a.m. Patient #4 was observed on the treatment floor of the facility at station #3. The patient was receiving hemodialysis treatment at a blood flow rate of 400 mL/min and ultrafiltration rate of 720 mL/hr. via a right central venous catheter. Vital signs were as follows: blood pressure 113/56 mmHg and pulse 60 beats per minute. Review of the patient’s clinical record on 11/20/2024 revealed the following: Treatment sheet dated 11/04/2024: Review of treatment sheet dated 11/04/2024 revealed the following documentation: 06:15 a.m.: documented blood pressure of 121/75 mmHg and pulse rate of 68 beats per minute - Treatment initiated 06:30 a.m. - 08:00 a.m. the patient had no reportable vital signs or complaints 08:17 a.m.: documented blood pressure of 152/65 mmHg and pulse rate of 67 beats per minute 08:30 a.m.: documented blood pressure of 138/65 mmHg and pulse rate of 67 beats per minute - PCT documented, “pt cramping” 08:35 a.m.: documented blood pressure of 139/78 mmHg and pulse rate of 66 beats per minute - PCT documented, “pt stable, uf/off cramps” 09:00 a.m.: documented blood pressure of 161/86 mmHg and pulse rate of 60 beats per minute - PCT documented, “Patient watching TV, access visible” 09:15 a.m.: documented blood pressure of 156/83 mmHg and pulse rate of 65 beats per minute - PCT documented, “Patient Alert/awake” 09:18 a.m.: documented blood pressure of 133/69 mmHg and pulse rate of 68 beats per minute - PCT documented, “Patient Cramping” 09:30 a.m.: documented blood pressure of 156/86 mmHg and pulse rate of 74 beats per minute - PCT documented, “Patient Alert/awake” 09:45 a.m.: documented blood pressure of 173/74 and pulse rate of 62 beats per minute - Treatment ended - PCT documented, “Patient Normal Saline Administered” 9:50 a.m.: registered nurse documented the post treatment assessment which revealed “Alert: Yes, Oriented To: Time, Place, Person, Cooperative: Yes, Lungs: Clear, Heart Rhythm: Regular, LE Edema: None, Pedal Edema: +2, Facial Edema: No, Periorbital Edema: No, Appetite: Good, Nausea/Vomiting: None, Pain: 0, Shortness of Breath: No, Ambulatory Status: Stretcher, AVF/AVG Hemostasis Achieved: Yes; “pt tolerated tx well, denies distress” There was no charge nurse notification by the PCT of turning off the patient’s ultrafiltration and of the patient cramping. There was no nursing assessment on the patient for cramping. The registered nurse documented that the patient tolerated the treatment well in the Post Dialysis Assessment. Patient #6 On 11/20/2024 at 8:16 a.m. Patient #6 was observed on the treatment floor of the facility at station #1. The patient was receiving hemodialysis treatment at a blood flow rate of 350 mL/min and ultrafiltration rate of 1000 mL/hr. via a left lower arm vascular access. Vital signs were as follows: blood pressure 122/82 mmHg and pulse 100 beats per minute. Review of the patient’s clinical record on 11/20/2024 revealed the following: Treatment sheet dated 11/06/2024: Review of treatment sheet dated 11/06/2024 revealed the following documentation: 05:50 a.m.: documented blood pressure of 121/78 mmHg and pulse rate of 72 beats per minute - Treatment initiated 05:55 a.m. - 08:20 a.m. the patient had no reportable vital signs or complaints 08:32 a.m.: documented blood pressure of 117/61 mmHg and pulse rate of 96 beats per minute - PCT documented, “PT complaint palpitations, UF off per RN __ (Staff ID: E - who is an LVN and not the CN) UFR set to OFF” 08:50 a.m.: documented blood pressure of 98/82 mmHg and pulse rate of 100 beats per minute - PCT documented, “Patient - Alert/awake” 08:50 a.m.: documented blood pressure of 133/73 and pulse rate of 93 beats per minute - PCT documented, “Treatment Ended - All blood returned” 08:55 a.m.: registered nurse documented the post treatment assessment which revealed “Alert: Yes, Oriented To: Time, Place, Person, Cooperative: Yes, Lungs: Clear, Heart Rhythm: Regular, LE Edema: 2+, Pedal Edema: +2, Facial Edema: No, Periorbital Edema: No, Appetite: Good, Nausea/Vomiting: None, Pain: 0, Shortness of Breath: No, Ambulatory Status: Ambulates Independently, AVF/AVG Hemostasis Achieved: Yes; “pt tolerated tx well.” There was no charge nurse notification by the PCT of turning off the patient’s ultrafiltration and of the patient complaint of palpitations. The registered nurse documented that the patient tolerated the treatment well in the Post Dialysis Assessment. Interview with Clinical Nurse Manager (B) on 11/20/2024 at 2:55 p.m. confirmed there was no charge nurse notification by the PCTs for patient complaints of cramping, palpitations, and turning off of the ultrafiltration during the hemodialysis treatments.”